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Individual
LAURA E TYLISZ
Active
Individual
LAURA E TYLISZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
0900360158
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300112912
—
IN
05
—
343900000X
—
IN
Enumeration date
10/23/2025
Last updated
10/23/2025
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